Avaliação clínica do uso de uma única placa para fixação da osteotomia sagital do ramo mandibular

• Autor(a) principal: Babadopulos, Carlos Nicolau Feitosa de Albuquerque Lima
• Data de Publicação: 2015
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da USC
• Texto Completo: http://tede2.usc.br:8080/jspui/handle/tede/305
• topic: Osteotomia sagital do ramo mandibular; Cirurgia ortognática; Placas ósseas; Assimetria facial; Avanço mandibular; Sagittal splitt ramus osteotomy; Orthognathic surgery; Bone plates; Mandibular advancement; Asymmetry facial; ODONTOLOGIA::CIRURGIA BUCO-MAXILO-FACIAL

The sagittal split ramus osteotomy (SSRO) is a surgical technique often used in orthognathic surgery. The shape and fixation technique for adequate stabilization of the SSRO remains controversial. The aim of this study was to evaluate the stability of the fixation of SSRO with the use of a single specific plate for this procedure, called sagittal plate. This retrospective study was performed by clinical analysis of medical records of patients undergoing orthognathic surgery with the use of this plate in setting the SSRO. A total of 34 medical records of these patients, of which 23 (67.65%) underwent bimaxillary surgery and 11 (32.35%) to monomaxillary surgeries, all with the performance of bilateral SSRO. One of the patients who had hemifacial microsomia the fixing with the sagittal plate was performed only on the right side and the left side, which affected side, a reconstruction plate was used. Sixty-seven (67) plates containing 3 sagittal nonlinear holes on each side with an intermediate semi curved and with varying lengths were used. The extensions varied in medium (9.5 mm) with 20 plates, long (from 12.5 mm) with 17, extra long (from 15.5 mm) with 19 extra long of 18.5 mm with 11 boards. In 62 (92.54%) of the 67 surgical approaches was conducted only the intraoral access to fixation with a single sagittal plate and the other 5 (7:46%) was necessary to associate trancutaneous access to additional fixing bicortical screw (hybrid technique) in 4 (5.97%) of the fixations and only one setting where it was only used the plate. There were five (7.46%) complications related to fixation in 67 osteosynthesis: four (5.97%) total losses of fixations and one (1.49%) infection. There was a further complication, but without changing the osteosynthesis in one (2.94%; 1/34) of the 34 patients treated: occlusal change, related to condylar resorption, with a total of 6 (17.65%; 6/34) complications. Of the 63 osteosynthesis performed only with a single plate there were only 4 (6.34%) fixation losses, where these only 2 (3.17%) required another surgery on the same patient, to a new setting. The complications that occurred were mostly related to cases where large movement magnitudes were required. We found that a single board, with a new design (sagittal plate), provided adequate stabilization of mandibular bone segments during SSRO.